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Authors:Davison J; McLaughlin M, Giles M.Abstract: BackgroundDespite the popularity of the theory of planned behaviour (TPB), a lack of research assessing the efficacy of the model in understanding the health behaviour of children exists. The aim of this study was to develop and test a TPB-based measure suitable for use with schoolchildren aged 9–10 years.MethodsA mixed-method sequential design was employed. In Phase 1, semi-structured focus group discussions were conducted to elicit the underlying beliefs specific to tooth brushing. Using content thematic analysis, the beliefs were identified and a TPB measure was developed. A repeated measures design was employed in Phase 2 using test–retest reliability analysis in order to assess its psychometric properties. In all, 184 children completed the questionnaire.ResultsThe questionnaire proved to be reliable for assessing the tooth brushing beliefs of children. Pearson's product moment correlations were calculated for all of the TPB constructs, achieving substantial to almost perfect agreement levels, providing strong predictive power of the TPB.ConclusionsThe design and development of the measure are described, which could serve as a guide to fellow researchers and health professionals interested in using theoretical models to investigate the health and well-being of children.PubDate: Thu, 23 Nov 2017 00:00:00 GMTDOI: 10.1093/pubmed/fdw120Issue No:Vol. 39, No. 4 (2017)

Authors:Gibson L; Hernández Alava M, Kelly M, et al.Abstract: BackgroundMany studies have found a statistical association between breastfeeding and childhood adiposity. This paper investigates whether breastfeeding has an effect on subsequent childhood body mass index (BMI) using propensity scores to account for confounding.MethodsWe use data from the Millennium Cohort Study, a nationally representative UK cohort survey, which contains detailed information on infant feeding and childhood BMI. Propensity score matching is used to investigate the mean BMI in children breastfed exclusively and partially for different durations of time.ResultsWe find statistically significant influences of breastfeeding on childhood BMI, particularly in older children, when breastfeeding is prolonged and exclusive. At 7 years, children who were exclusively breastfed for 16 weeks had a BMI 0.28 kg/m2 (95% confidence interval 0.07 to 0.49) lower than those who were never breastfed, a 2% reduction from the mean BMI of 16.6 kg/m2.ConclusionsFor this young cohort, even small effects of breastfeeding on BMI could be important. In order to reduce BMI, breastfeeding should be encouraged as part of wider lifestyle intervention. This evidence could help to inform public health bodies when creating public health guidelines and recommendations.PubDate: Sat, 09 Sep 2017 00:00:00 GMTDOI: 10.1093/pubmed/fdw093Issue No:Vol. 39, No. 4 (2017)

Authors:Lynch J.Pages: 653 - 660Abstract: BackgroundPoliticians in many countries have embraced the notion that health inequalities derive from socioeconomic inequalities, but European governments have for the most part failed to enact policies that would reduce underlying social inequalities.MethodsData are drawn from 84 in-depth interviews with policy-makers in four European countries between 2012 and 2015, qualitative content analysis of recent health inequalities policy documents, and secondary literature on the barriers to implementing evidence-based health inequalities policies.ResultsInstitutional and political barriers are important barriers to effective policy. Both policy-making institutions and the ideas and practices associated with neoliberalism reinforce medical-individualist models of health, strengthen actors with material interests opposed to policies that would increase equity, and undermine policy action to tackle the fundamental causes of social (including health) inequalities.ConclusionsMedicalizing inequality is more appealing to most politicians than tackling income and wage inequality head-on, but it results in framing the problem of social inequality in a way that makes it technically quite difficult to solve. Policy-makers should consider adopting more traditional programs of taxation, redistribution and labor market regulation in order to reduce both health inequalities and the underlying social inequalities.PubDate: Mon, 09 Jan 2017 00:00:00 GMTDOI: 10.1093/pubmed/fdw140Issue No:Vol. 39, No. 4 (2017)

Authors:Farrants K.Pages: 661 - 667Abstract: Background’Recommodification’ describes the withdrawal of previously extended social welfare, making living standards more dependent on market position. Since health is influenced by living standards, recommodification is expected to be associated with increased health inequalities.AimThis study investigates the recommodification of two policy domains: unemployment insurance and pensions, and their link to health inequalities between 1991 and 2011.MethodsTwo case studies were used. Using data from Health Survey for England and the Swedish Study of Income and Living Conditions, the magnitudes of health inequalities between the employed and unemployed, and between high and low educated pensioners, were computed. The magnitudes were then associated with net replacement rates of pensions and unemployment benefits.ResultsRecommodification had a stronger association with health inequalities in Sweden than in England, and a stronger association with health inequalities between the employed and unemployed than in the retired population.ConclusionThe relationship between decommodification is not linear, but is shaped by other factors in the social context. However, recommodification has a positive or negligible association with health inequalities. In no case was there a negative association between recommodification and health inequalities.PubDate: Sat, 04 Feb 2017 00:00:00 GMTDOI: 10.1093/pubmed/fdx001Issue No:Vol. 39, No. 4 (2017)

Authors:Garnham L.Pages: 668 - 677Abstract: BackgroundThe UK has long had a strong commitment to neoliberal policy, the risks of which for population health are well researched. Within Europe, Scotland demonstrates especially poor health outcomes, much of which is driven by high levels of deprivation, wide inequalities and the persistent impacts of deindustrialisation. The processes through which neoliberalism has contributed to this poor health record are the subject of significant research interest.MethodsQualitative case study of a post-industrial town in west central Scotland. Primary data were collected using photovoice (11) and oral history (9) interviews, supplemented by qualitative and quantitative secondary source data.ResultsFor those who fared poorly after the initial introduction of neoliberal policy in the 1970s, subsequent policy decisions have served to deepen and entrench negative impacts on the determinants of health. Neoliberalism has constituted a suite of rapidly and concurrently implemented policies, cross-cutting a variety of domains, which have reached into every part of people's lives.ConclusionsIn formerly industrial parts of west central Scotland, policy developments since the 1970s have generated multiple and sustained forms of deprivation. This case study suggests that a turn away from neoliberal policy is required to improve quality of life and health.PubDate: Thu, 02 Mar 2017 00:00:00 GMTDOI: 10.1093/pubmed/fdx019Issue No:Vol. 39, No. 4 (2017)

Authors:Kelly M; Atkins L, Littleford C, et al.Pages: 678 - 684Abstract: BackgroundIn 2013, many public health functions transferred from the National Health Service to local government in England. From 2006 NICE had produced public health guidelines based on the principles of evidence-based medicine. This study explores how the guidelines were received in the new environment in local government and related issues raised relating to the use of evidence in local authoritites.MethodsIn depth, interviews with 31 elected members and officers, including Directors of Public Health, from four very different local government organizations (‘local authorities’).ResultsParticipants reported that (i) there were tensions between evidence-based, and political decision-making; (ii) there were differences in views about what constituted ‘good’ evidence and (iii) that organizational life is an important mediator in the way evidence is used.ConclusionsDemocratic political decision-making does not necessarily naturally align with decision-making based on evidence from the international scientific literature, and local knowledge and local evidence are very important in the ways that public health decisions are made.PubDate: Fri, 10 Feb 2017 00:00:00 GMTDOI: 10.1093/pubmed/fdx002Issue No:Vol. 39, No. 4 (2017)

Authors:Doyle Y; Mills A, Korkodilos M.Pages: 685 - 690Abstract: Around 150 cities have emerged as notable at a global scale. With a global population of fewer than 12%, they generate 46% of world gross domestic product. There is growing interest in how cities can accelerate health improvements through wider social and economic collaboration. A team led by Public Health England in London visited counterparts in New York City and Paris to examine how city health leaders addressed public health challenges. The three cities have similar health challenges but different legal, political and fiscal resources for promoting and protecting health. Consequently, there is no single model that every city could adopt. Organizational structures, interpersonal relationships and individual skills can play an important part in effective delivery of better city health. Lack of access to published evidence on how practice has been influenced by city health policies hampers learning between cities. There is little easily comparable data to guide those interested in such learning. Municipal governments are ideally situated to join researchers to fill this gap in the literature.PubDate: Sat, 18 Mar 2017 00:00:00 GMTDOI: 10.1093/pubmed/fdx031Issue No:Vol. 39, No. 4 (2017)

Authors:Charlesworth K; Jamieson M.Pages: 691 - 697Abstract: BackgroundDue to the climate crisis, it is increasingly evident that countries will have to decarbonize. Healthcare, which has a large carbon footprint and uses vast quantities of resources, will have to undergo significant transformation. In this research, we sought the ideas of leading thinkers in the field, to address the question of how health systems can provide high-quality care in a carbon-constrained world.MethodsSemi-structured, qualitative in-depth interviews with 15 healthcare thought leaders from Australia, the UK, the USA and New Zealand. The interviews were transcribed and analysed by matrix display and thematic analysis.Results‘Green’ initiatives such as improving energy efficiency and implementing travel plans will be insufficient to achieve the scale of decarbonization required. According to the thought leaders in our study, it is likely that greater carbon and resource savings will come from thinking much more broadly about innovative models of care and using ‘new’ sources of ‘value’ such as ‘people’ and ‘relationships’.ConclusionsUsing human resources and human interactions as low-carbon sources of value in healthcare are promising models.PubDate: Wed, 18 Jan 2017 00:00:00 GMTDOI: 10.1093/pubmed/fdw146Issue No:Vol. 39, No. 4 (2017)

Authors:Allen L; Cobiac L, Townsend N.Pages: 698 - 703Abstract: BackgroundNon-communicable diseases (NCDs) have slowly risen to the top of the global health agenda and the reduction of premature NCD mortality was recently enshrined in Target 3.4 of the UN Sustainable Development Goals. The unequal global distribution of NCDs is inadequately captured by the most commonly cited statistics.MethodsWe analyzed ‘WHO Global Health Estimates’ mortality data to calculate the relative burden of NCDs for each World Bank income group, including the ‘risk of premature NCD death’ based on methods in the WHO Global Status Report. We included all deaths from cardiovascular disease, all cancers, respiratory diseases and diabetes in people aged 30–69 years.ResultsDeveloping countries experience 82% of absolute global premature NCD mortality, but they also contain 82% of the world's population. Examining relative risk shows that individuals in developing countries face a 1.5 times higher risk of premature NCD death than people living in high-income countries. Premature NCD death rates are highest in lower middle-income countries.ConclusionsAlthough numbers of deaths are useful to describe the absolute burden of NCD mortality by country type, the inequitable distribution of premature NCD mortality for individuals is more appropriately conveyed with relative risk.PubDate: Fri, 10 Feb 2017 00:00:00 GMTDOI: 10.1093/pubmed/fdx008Issue No:Vol. 39, No. 4 (2017)

Authors:Kuhdari P; Previato S, Giordani M, et al.Pages: 730 - 737Abstract: BackgroundHuman papillomavirus (HPV) infection is the main cause of cervical cancer and plays a relevant role in the development of genital warts and of the cancer of penis and anus, head/neck, oropharynx and genitourinary system. The aim of this study is the evaluation of hospitalizations due to HPV-related pathologies in 2001–12 in Italy.MethodsThe national hospital discharge forms were provided by the Ministry of Health. The HPV-related hospitalizations were identified using specific diagnostic codes, accordingly to the ICD-9-CM coding system. The proportion of hospitalizations of potentially HPV-related pathologies, obtained from the literature, was evaluated as well as the hospitalization rates (hr) and their trend over time.ResultsUterine cervical cancer and CIN III accounted for 40% of hospitalizations (hr: 15.6/100 000 and 17.6/100 000, respectively). Head/neck and oropharynx pathologies accounted for 24.5% of cases (hr: 16/100 000 and 3.9/100 000, in males and females, respectively), followed by genital warts (17.3% of hospitalizations; hr: 7.5/100 000 in males and 8.52/100 000 in females), anal (8.1% of hospitalizations), genitourinary (7.7%) and penis cancers (2.2%).ConclusionsThe study, even if limited to the evaluation of hospitalizations, points out how HPV-related pathologies continue to be a relevant public health issue in Italy with a high impact on population.PubDate: Tue, 14 Mar 2017 00:00:00 GMTDOI: 10.1093/pubmed/fdx025Issue No:Vol. 39, No. 4 (2017)

Authors:Kazemi D; Borsari B, Levine M, et al.Pages: 763 - 776Abstract: BackgroundThe use of social media (SM) as a surveillance tool of global illicit drug use is limited. To address this limitation, a systematic review of literature focused on the ability of SM to better recognize illicit drug use trends was addressed.MethodsA search was conducted in databases: PubMed, CINAHL via Ebsco, PsychINFO via Ebsco, Medline via Ebsco, ERIC, Cochrane Library, Science Direct, ABI/INFORM Complete and Communication and Mass Media Complete. Included studies were original research published in peer-reviewed journals between January 2005 and June 2015 that primarily focused on collecting data from SM platforms to track trends in illicit drug use. Excluded were studies focused on purchasing prescription drugs from illicit online pharmacies.ResultsSelected studies used a range of SM tools/applications, including message boards, Twitter and blog/forums/platform discussions. Limitations included relevance, a lack of standardized surveillance systems and a lack of efficient algorithms to isolate relevant items.ConclusionIllicit drug use is a worldwide problem, and the rise of global social networking sites has led to the evolution of a readily accessible surveillance tool. Systematic approaches need to be developed to efficiently extract and analyze illicit drug content from social networks to supplement effective prevention programs.PubDate: Tue, 14 Mar 2017 00:00:00 GMTDOI: 10.1093/pubmed/fdx020Issue No:Vol. 39, No. 4 (2017)

Authors:So E.Pages: 777 - 786Abstract: BackgroundThis study aimed to investigate perceptual body image and the relationship between perceived body image (PBI) and weight control differentiated according to obesity categories across the adult lifespan by sex among Koreans.MethodsWe analyzed data on 10 198 adults aged 25 or older from the Korean National Health and Nutrition Examination Survey of a nationally representative sample of non-institutionalized Koreans.ResultsSignificant discordance between PBI and body mass index (BMI) or waist circumference (WC) was found in all age groups in both sexes, and the discordance for obesity grew more severe with age. Linear associations between PBI and BMI or WC were found in normal weight and obese groups in all age groups in both sexes, with relatively greater BMI or WC differences for PBI found in obese men aged ≤64 or ≤44, respectively, and obese women of all ages or aged ≥75, respectively, compared to normal weight. Obese women aged ≥65 (BMI) or ≥75 (WC) and obese men in the 45–54 and 65–74 age groups (BMI and WC) had significant association between PBI and weight control.ConclusionsInterventions regarding accurate body size perception should be prioritized for obese women aged ≥65 or ≥75 and for obese men aged 45–54 and 65–74.PubDate: Mon, 27 Feb 2017 00:00:00 GMTDOI: 10.1093/pubmed/fdx021Issue No:Vol. 39, No. 4 (2017)

Authors:Watson W; Lau V, Wellard L, et al.Pages: 787 - 792Abstract: BackgroundIn response to rising childhood obesity rates, the Australian food industry implemented two initiatives in 2009 to reduce the marketing of unhealthy food to children. This study evaluated the efficacy of these initiatives on the rate of unhealthy food advertising to children on Australian television.MethodsThe rates of food advertisements on three free-to-air commercial television channels and a youth-oriented digital channel in Sydney, Australia were analysed over 2 weekdays (16 h) and two weekend days (22 h). Advertisements were categorized according to the healthiness of foods advertised (non-core, core, miscellaneous) and signatory status to the food industry advertising initiatives.ResultsTotal food advertising rates for the three channels increased from 5.5/h in 2011 to 7.3/h in 2015, due to an increase of 0.8/h for both core and miscellaneous foods. The rate of non-core food advertisements in 2015 (3.1/h) was similar to 2011 (3.0/h). The youth-oriented channel had fewer total food advertisements (3.7/h versus 7.3/h) but similar fast-food advertisement rates (1.3/h versus 1.3/h).ConclusionsThere was no change in the rate of unhealthy food advertising since 2011, suggesting minimal impact of the current food industry initiatives on reducing children's exposure to unhealthy food advertising.PubDate: Thu, 02 Feb 2017 00:00:00 GMTDOI: 10.1093/pubmed/fdx004Issue No:Vol. 39, No. 4 (2017)

Authors:Garnham L; Harkins C.Pages: 793 - 795Abstract: We previously contributed a short discussion piece to this section, which described some of the challenges inherent in evaluating the public health impacts of an arts-based social intervention, Sistema Scotland's 'Big Noise' programmes. This contribution aims to follow-up by exploring two interwoven aspects of these difficulties in more detail. The first is the role of participants’ experiences of challenge and struggle, as part of their engagement with the main, orchestral element of this intervention, in generating the impacts on confidence and self-esteem that we identified in our initial evaluation. The second is the role of music, the learning of instrumental skills and the undertaking of orchestral performances in underpinning these outcomes.PubDate: Wed, 09 Aug 2017 00:00:00 GMTDOI: 10.1093/pubmed/fdx098Issue No:Vol. 39, No. 4 (2017)

Authors:Bird E; Oliver B.Pages: 796 - 804Abstract: BackgroundThis study assessed short-term changes in children's health and illness attitudes and health status following Facts4Life, a school-based health education intervention.MethodsChildren aged 7–11 years (School Years 3–6) recruited from 10 schools in the UK participated in this study. A quasi-experimental design was utilized with 187 children participating in the intervention, and 108 forming a control condition. Children in both conditions completed measures of health and illness attitudes and health status at baseline and at immediate follow-up. Intervention effects were examined using mixed between-within subjects analysis of variance.ResultsAnalysis revealed significant baseline to follow-up improvements in intervention group responses to ‘When I feel unwell I need to take medicine to feel better’ (Years 3 and 4: P = 0.05, η2p = 0.02; Years 5 and 6: P = 0.004, η2p = 0.07). For intervention group children in Years 5 and 6 there was an improvement in response to ‘When I am ill, I always need to see a doctor’ (P = 0.01, η2p = 0.07). There was no evidence that Facts4Life had an impact upon health status.ConclusionsThis study identified some positive intervention effects and results suggest that Facts4Life has potential as a school-based health education intervention.PubDate: Fri, 10 Feb 2017 00:00:00 GMTDOI: 10.1093/pubmed/fdx003Issue No:Vol. 39, No. 4 (2017)

Authors:Humphreys C; Lee A, Offer C, et al.Pages: 821 - 827Abstract: BackgroundThe majority of tuberculosis (TB) cases in the UK occur among people born in high-burden countries (73%), and are concentrated in large urban centres. This study explores migrants’ attitudes and beliefs towards TB in an English District where the incidence is higher than the UK average.MethodsCommunity engagement workers ran 26 focus groups using a standardized questionnaire. Purposeful sampling was used to obtain a cross-section of migrant communities. The summary reports were analysed using thematic analysis.ResultsMost groups did not see TB as a current issue in their community and associated it either with the past or with their country of birth. It appeared to be rarely discussed in their communities and generally not noted as being associated with stigma.ConclusionsThis study revealed a change in social attitudes to TB in migrant groups to those reported in previous literature. Stigma had considerably less effect than expected. However, the evidence revealed that these high-risk groups made the erroneous assumption that, by moving to a low incidence country, they were no longer at risk of the disease. TB services need to respond by revising the information that they provide to take into account the risk perception of these populations.PubDate: Sat, 17 Jun 2017 00:00:00 GMTDOI: 10.1093/pubmed/fdx061Issue No:Vol. 39, No. 4 (2017)

Authors:Chrysanthaki T; Fernandes B, Smith S, et al.Pages: 828 - 840Abstract: BackgroundThe effectiveness and efficiency of memory assessment services (MASs) is unknown. Our aim was to determine if a typology can be constructed, based on shared structural and process characteristics, as a basis for a non-randomized evaluation of their effectiveness and cost-effectiveness.MethodsSurvey of random sample of 73 MASs in 2015; comparison of characteristics and investigation of inter-correlation.ResultsIt was not possible to group characteristics to form the basis of a typology of MASs. However, there was considerable variation in staff numbers (20-fold), new patients per whole-time equivalent (WTE) staff (20-fold), skill mix and the nurse:doctor ratio (1–10).The operational performance also varied: first appointments (50–120 minutes); time for first follow-up (2–12 weeks); frequency of follow-up in first year (1–5). These differences were not associated with the number of new patients per WTE staff or the accreditation status of the MAS.Post diagnosis, all MASs provided pharmacological treatment but the availability of non-pharmacological support varied, with half providing none or only one intervention while others providing four or more.ConclusionsIn the absence of any clear typology, evaluation of MASs will need to focus on the impact of individual structural and process characteristics on outcomes.PubDate: Thu, 02 Mar 2017 00:00:00 GMTDOI: 10.1093/pubmed/fdx018Issue No:Vol. 39, No. 4 (2017)

Authors:Seifan A; Ganzer C, Vermeylen F, et al.Pages: 863 - 873Abstract: BackgroundUnderstanding health beliefs and how they influence willingness will enable the development of targeted curricula that maximize public engagement in Alzheimer’s disease (AD) risk reduction behaviors.MethodsLiterature on behavioral theory and community input was used to develop and validate a health beliefs survey about AD risk reduction among 428 community-dwelling adults. Principal component analysis was performed to assess internal consistency. Linear regression was performed to identify key predictors of Willingness to engage in AD risk reduction behaviors.ResultsThe measure as well as the individual scales (Benefits, Barriers, Severity, Susceptibility and Social Norm) were found to be internally consistent. Overall, as Benefits and Barriers scores increased, Willingness scores also increased. Those without prior AD experience or family history had lower willingness scores. Finally, we observed an interaction between age and norms, suggesting that social factors related to AD prevention may differentially affect people of different ages.ConclusionsThe Alzheimer Prevention Beliefs Measure provides assessment of several health belief factors related to AD prevention. Age, Family History, Logistical Barriers and total Benefits are significant determinants of willingness to engage in AD risk reduction behaviors, such as seeing a doctor or making a lifestyle change.PubDate: Mon, 09 Jan 2017 00:00:00 GMTDOI: 10.1093/pubmed/fdw145Issue No:Vol. 39, No. 4 (2017)